- Insured has to arrange for the Request for Authorisation Letter (RAL) ( Cashless Request Form )from Hospital, also known as Provider ( Hospital Network ) immediately after obtaining due details from the treating doctor in the form, prescribed by the Authority. The RAL shall be sent alongwith all the relevant details in the Email/ Fax to the 24-hour authorization /cashless department of Paramount along with contact details of treating physician and the insured.
- In case of planned admission- the RAL shall reach the authorization department of Paramount 48 hours prior to the expected date of admission.
- The RAL form shall be duly filled, clearly mentioning ‘Yes’ or ‘No’ against all fields of the form and/or the details as required. The form shall not be sent with ‘Nil’ or blank replies.
- Paramount guarantees payment only after receipt of RAL and the necessary medical details, and subject to Policy Terms and Conditions.
Cashless Hospitalization Documents
At the time of discharge, insured needs to sign duly filled Claim form ( Claim form )and necessary hospital documents ( Document Checklist). Hospital will submit all those documents to TPA for further processing of the Claim.
What happens at backend if Cashless is requested?
On receipt of request for Cashless hospitalization at Paramount, the Medical team at Paramount will determine whether the condition requires admission and if the treatment is covered under your health insurance policy. They will also check all the other terms and conditions of your insurance policy. Non-medical expenses will not be payable. (List of Non Payable)
- In case coverage is available,Paramount will issue an approval to the hospital for a specified amount depending on the disease, treatment, how much you are insured for, etc. This is sent by fax and/or email (if available). The approval is called a “Preauthorization”. This preauthorization entitles you to avail cashless facility at the hospital without paying for the medical expenses. Note: Further enhancement approvals may be issued on enhancement request, subject to terms and conditions of the policy.
- In case of any deficiency or query,an additional information letter will be sent to the Hospital. On retrieval of the required and complete information from you, the request will be processed.
- Based on the processing of the claim, a denial or approval is executed.
- Please note that denial of a preauthorization request is in no way to be construed as denial of treatment or denial of coverage. You can proceed with the treatment, settle the hospital bills and submit the claim for a possible reimbursement.
- At the time of discharge, please make sure that you check and sign the original bills and discharge summary. Please carry a copy of the signed bill, discharge summary and all your investigation reports for your records. This is for your reference and will be useful to you in the future.
What if the final bill is higher at the time of discharge?
If treatment cost is increased during hospitalization, hospital may send request to Paramount for an additional sanction. Paramount will sanction additional cashless, subject to availability of balance Sum Insured and as per policy terms and conditions.
In case of no further guarantee of payment from Paramount, Insured needs to settle the remaining amount prior to discharge.
(Please be aware of room rent eligibility. If admitted in a room higher than admissible as per the policy terms, there will be a deduction of a proportionate amount of the claim after excluding cost of medicines etc.)
How to file a claim if insured gets hospitalized in non-network hospital
Reimbursement claims can be submitted to Paramount through courier, post or in-person at any of our branches. Claim documents should be sent to Paramount as per policy guidelines issued by insurer. Claim forms can be collected from the nearest Divisional / Branch Office of the Insurance company / Paramount office or Claim forms can be downloaded from here Issuance of claim form does not mean guarantee of payment or any liability, under the policy on the part of the insurers.